Lab Values Flashcards
CCT/ICU Lab Values
What are the Normal ABG Values?
pH: 7.35-7.45
CO2: 35-45
HCO3: 22-26
PaO2: 65-100
SPO2: 94-100%
BE: 2 +/- 2
Critical ABGs Value?
What does this mean?
pH < 7.2
pCO2 > 55
pO2 < 60
Critical ABG’s that require Intubation
Sodium (Na+)
Normal Range: 135 - 145 mEq/L
Hyponatremia
Sodium (Na+) < 135 mEq/L
Signs and symptoms: behavioral problems, muscle twitching, and cardiac abnormalities
Treatment: Corrected slowly to avoid neurological problems- with isotonic fluid NS/LR
Potassium (K+)
Normal Range: 3.5 – 5.0 mEq/L
MOST DANGEROUS ABNORMALITY
Hyperkalemia
Potassium (K+) > 5.0 mEq/L
Signs and symptoms: abdominal cramps, nausea, hypotension, bradycardia, numbness (especially in the legs)
Treatment:
Push K+ into the cells: CaCl /Ca Gluconate, Insulin, D10/50, high dose Albuterol.
Remove K+: Lasix, Kayexalate
K+ will change about 0.6 mEq/L for every 0.1 change in pH
Hypokalemia
Potassium (K+)< 3.5 mEq/L
Signs and symptoms: malaise, weakness, history of poor dietary intake.ECG shows Depressed,Inverted, or Flattened T
Waves
Treatment:Oral potassium 60 mEq,
10 mEq IV potassium NEVER give as a bolus (could be fatal IV Potassium is used in lethal injections)
Chloride (Cl-)
96-106 mEq/L
Extracellular anion
Tends to shift with Na+
Carbon Dioxide (Total CO2)
22-26 mEq/L
Blood Urea Nitrogen (BUN)
8-23 mg/dL
Helps provide a picture of Renal (kidney) clearance
Creatinine (Cr)
0.7 to 1.4 mg/dL
Helps provide a picture of renal clearance
BUN/Creatinine Ratio
What does High/Low value mean?
The normal BUN/Creatinine ratio range is 5 – 20 mg/dL.
A High ratio indicates dehydration, Hyperthyroidism, and Kidney disease
A low ratio indicates-Sickle cell anemia, Rhabdomyolysis, Hypothyroidism, Kidney damage, and kidney failure
Glucose (Glu)
70-110 mg/dL
What Labs are in Chem 7 (BMP)
Magnesium
1.7 to 2.2 mg/dL
Hypermagnesemia
Mg > 2.3 mg/dl
Hypermagnesemia is an uncommon problem in the absence of magnesium admission.
Signs and symptoms: Nausea, flushing, headache, lethargy, drowsiness, and diminished deep tendon reflexes, muscle paralysis leading to flaccid quadriplegia, apnea, and respiratory failure, complete heart block
Treatments - Intravenous calcium and Dialysis
Hypomagnesemia
Mg > 1.7 mg/dl
Signs and symptoms: tetany, arrhythmias, or seizures
History-alcoholics, pregnant or up to 3 mth after birth
Treatment: Receive intravenous (IV) magnesium
Total Calcium (Ca++ TOT)
8.5 - 10.2 mg/dL
The most essential electrolyte in the body
Found in 3 states:
47% Free: dispersed in body fluids
43% bound: bound to proteins, mainly albumin
10% chelated: bound to molecules (citrate, lactate,phosphate, etc)
Ionized Calcium (iCa)
4.5 – 5.6 mg/dL
Determines total body calcium to free calcium
Hypocalcemia
Ca++ TOT < 8.5 mg/dl or iCa < 4.4
Blood transfusions,Sepsis, Low levels of Albumin
Signs and symptoms: Anxiety, confusion, delirium, Hyperactive Deep Tendon Reflexes
Prolonged QT interval on EKG, narrow QRS, possible U wave
Treatment IV 3g of Ca gluconate or IV 1g of CaCl2
Chvostek’s Sign- Cheek muscle spasms when the facial nerve (CN VII) tapped(just in front of the ear). “Chvostek’s = Cheek.”
Trousseau’s Sign-Forearm tetany when blood pressure cuff is inflated
Hypercalcemia
CaTOT++> 10.2 mg/dl
Tumor on the parathyroid (Hyperparathyroidism)Tuberculosis Thiazide diuretics Kidney transplant
Signs and symptoms: AMS, decreased reflexes
Treatment: Magnesium sulfate 2g over 10min
What values are in a Complete Blood Count (CBC)
Red Blood Cells (RBCs)
5 million (avg)
Values vary based on gender
Hemoglobin (Hgb)
15 g/dL (avg)
O2 binding protein
Values vary based on gender
Hematocrit (Hct)
45 %
Percentage of blood that is formed elements (cells) within plasma
White Blood Cells (WBCs)
4500/µL – 11,000/µL
Body’s Immune defense system
Platelets (Plt)
150K/µL – 400K/µL
Aid in clotting
Albumin
3.5-5.0 g/dL
Produced by the liver Decreased production is seen in patients with liver damage
Hypermagnesemia
Mg <2.2 mg/dL
Hypermagnesemia is an uncommon problem in the absence of magnesium admission.
Nausea, flushing, headache, lethargy to somnolence, drowsiness,diminished or absent deep tendon reflexes hypocalcemia, hypotension, bradycardia, and electrocardiogram (ECG) changes
Treatment: IV 3g of Ca gluconate or IV 1g of CaCl2
VBG normal values
VpH 7.31-7.41
VpCO2 42-52 mmhg
VpHCO3 22-27 mEq/L
VpO2 30-50mmHg
VBE -3 +/- 3
A PaO2 of 60 mmHg is roughly equal to an SaO2 of
PaO2 = SpO2
40 mmHg=70%
50 mmHg= 80%
60 mmHg = 90%
90 mmHg =100%
pH and ETCO2 Relationship
For every change in _____, the ETCO2
, you should expect the pH to change_____ the _____direction
10 mmHg,0.08,opposite
For every change in 10 mmHg the ETCO2
, you should expect the pH to change 0.08 the opposite direction
pH and Bicarbonate (HCO3) Relationship
For each change of ____ in pH, you should expect HCO3 to change_____ in the ____ direction
0.15, 10 mmol/L,Same
For each change of 0.15 in pH, you should expect HCO3 to change 10 mmol/L in the same direction
pH and Potassium (K+) Relationship
For each change of ____ in pH, the K
+ will change ____ the ______ direction
0.10, 0.6 ,opposite
For each change of 0.10 in pH, the K
+ will change 0.6 the opposite direction
CO2 and Potassium (K+) Relationship
For each change of ____ in pH, the K+ will inversely change ____ mEqs in the ____ direction.
0.10,0.5,same
For each change of 0.10 in pH, the K+ will inversely change 0.5 mEqs in the same direction.
Coagulation Panel
PT 10 -13 sec (Prothrombin Time)
PTT 25 - 40 sec (Partial Thromboplastin Time)
INR 0.9 – 1.3 sec (International Normalized Ratio)
Anticoagulated patients (e.g. Coumadin)
Therapeutic INR 2 – 3 seconds
Coagulation Panel: What lab values test extrinsic and intrinsic pathways, and what pathophysiology and medication affect the pathways?
Memory tip: “You do PT outside.”
Extrinsic pathway-PT (Prothrombin Time) -Coumadin and Trauma
Intrinsic pathway-PTT (Partial Thromboplastin Time)- STEMI and Heparin
Coagulation Panel: INR 0.9 – 1.3 sec (International Normalized Ratio)
INR 0.9 – 1.3 sec (International Normalized Ratio)
Low means the blood clots faster.
High means the blood clots slower
Anticoagulated patients Therapeutic INR is 2 – 3 seconds
Liver Function Test ( 5 Test )
Alanine transaminase (ALT)
Aspartate transaminase (AST)
Alkaline phosphatase (ALP)
Albumin
Bilirubin
Alanine transaminase (ALT)
7 to 55U/L
The enzyme found in the liver that helps your body metabolize protein
Aspartate transaminase (AST)
8 to 48 U/L
The enzyme that helps metabolize alanine, an amino acid
An increase in AST levels indicates liver damage or disease, or muscle damage.
Alkaline phosphatase (ALP)
45 to 115 U/L
The enzyme in the liver, bile ducts, and bone.
Increased levels of ALP indicate liver damage/disease, such as a blocked bile duct, or certain bone
diseases
Albumin
3.5 to 5.0 g/dL
One of several proteins made in the liver
Decreased levels of may indicate liver damage or disease
Bilirubin
0.1 to 1.2 mg/dL
Produced during the normal breakdown of red blood cells
Passes through the liver and is excreted in stool
Elevated levels of bilirubin (jaundice) might indicate liver damage/disease or certain types of anemia
Lactate
0.5-1 mmol/L
Lactate concentration in blood is a measurement of anaerobic metabolism.
Hyperlactatemia: 2-4 mmol/L
Lactic Acidosis: >4-5 mmol/L
Elevated lactate level is most commonly caused by decreased blood flow to the cells (perfusion), systemically or locally.
Amylase
25-125 U/L
Produced in the pancreas and salivary glands
Amylase breaks down carbohydrates in food into simple sugars
A test used to detect Pancreatitis > 300 U/L
Elevates within 2 -12 hours
Lipase
0 - 160 U/L
Produced in the pancreas and salivary glands
Lipase breaks down fats
A test used to detect Pancreatitis
Levels >200 U/L, or up to 3 times the normal value based on specific lab
Elevates within 4 – 8 hours
Urine Output
“2/1/0.5” Rule
Infant 2 ml/kg/hr
Child 1 ml/kg/hr
Adult 0.5 ml/kg/hr 30-50 ml/hr
BNP (B-Type Natriuretic Peptide)
Values will increase in bloodwork, depending on the severity of CHF.
BNP is released by the atria in response to stretching and causes diuresis, reducing preload and afterload
< 100 pg/ml - No Heart Failure
> 300 pg/ml - Mild Heart Failure
> 600 pg/ml - Moderate Heart Failure
> 900 pg/ml - Severe Heart Failure
Cardiac Panel
Myoglobin,CK-MB,Troponin I,AST ,LDH
Troponin I
Onset/ Peak/Return to baseline
Troponin is a complex chemical molecule protein found in cardiac muscle in your body.
< 0.04 Normal
≥ 0.40 Probable myocardial infarction
> 0.60 High Probability of a STEMI
Onset 3-12 hours from after of chest pain
Peak value at 24-48 hours
Return to baseline over 5-14 days
Myoglobin
